Rates of change in the visual field and optic disc in patients with distinct patterns of glaucomatous optic disc damage.

PURPOSE

To investigate the rate of visual field and optic disc change in patients with distinct patterns of glaucomatous optic disc damage.

DESIGN

Prospective longitudinal study.

PARTICIPANTS

A total of 131 patients with open-angle glaucoma with focal (n = 45), diffuse (n = 42), and sclerotic (n = 44) optic disc damage.

METHODS

Patients were examined every 4 months with standard automated perimetry (SAP, SITA Standard, 24-2 test, Humphrey Field Analyzer, Carl Zeiss Meditec, Dublin, CA) and confocal scanning laser tomography (CSLT, Heidelberg Retina Tomograph, Heidelberg Engineering GmbH, Heidelberg, Germany) for a period of 4 years. During this time, patients were treated according to a predefined protocol to achieve a target intraocular pressure (IOP). Rates of change were estimated by robust linear regression of visual field mean deviation (MD) and global optic disc neuroretinal rim area with follow-up time.

MAIN OUTCOME MEASURES

Rates of change in MD and rim area.

RESULTS

Rates of visual field change in patients with focal optic disc damage (mean -0.34, standard deviation [SD] 0.69 dB/year) were faster than in patients with sclerotic (mean -0.14, SD 0.77 dB/year) and diffuse (mean +0.01, SD 0.37 dB/year) optic disc damage (P = 0.003, Kruskal-Wallis). Rates of optic disc change in patients with focal optic disc damage (mean -11.70, SD 25.5 ×10(-3) mm(2)/year) were faster than in patients with diffuse (mean -9.16, SD 14.9 ×10(-3) mm(2)/year) and sclerotic (mean -0.45, SD 20.6 ×10(-3) mm(2)/year) optic disc damage, although the differences were not statistically significant (P = 0.11). Absolute IOP reduction from untreated levels was similar among the groups (P = 0.59).

CONCLUSIONS

Patients with focal optic disc damage had faster rates of visual field change and a tendency toward faster rates of optic disc deterioration when compared with patients with diffuse and sclerotic optic disc damage, despite similar IOP reductions during follow-up.